Partial nephrectomy and radical nephrectomy offer similar cancer outcomes in renal cortical tumors 4 cm or larger.
ABSTRACT To determine whether the type of surgery (partial nephrectomy [PN] versus radical nephrectomy [RN]) has any effect on cancer outcome for renal cortical tumors 4 cm or larger. PN outcomes for large renal cortical tumors have been shown to be worse than outcomes for smaller tumors, but the upper limit of tumor diameter amenable to PN remains controversial.
We identified 33 patients from the Columbia University Comprehensive Urologic Oncology Database who underwent PN between 1988 and 2004 for renal cortical tumors 4 cm or larger. Each was matched with 2 patients undergoing RN on the basis of the tumor diameter. A survival analysis was conducted using the Kaplan-Meier method, and any differences between the two groups were compared using the log-rank test. The Cox regression model was used to determine which variables affected survival.
The estimated 5-year recurrence-free survival rate was 93.5% for the PN group and 83.3% for the RN group (P = 0.471). The estimated 5-year disease-specific survival rate was 96.2% for the PN group and 97.8% for the RN group (P = 0.893). Only tumor diameter had an impact on recurrence-free survival in the univariate (P = 0.005) and multivariate (P = 0.008) Cox regression models. Surgical technique had no impact on disease recurrence.
The results of our study have shown that cancer outcomes after PN do not differ from outcomes after RN for tumors of 4 cm or greater in diameter. The upper limit of 4 cm appears to have been determined arbitrarily. It is no longer advisable to restrict PN to patients with tumors smaller than 4 cm in diameter.
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ABSTRACT: The diagnosis and treatment of renal cell carcinoma (RCC) has been the subject of major changes since the late 1980s. Initially, surgery was the only treatment available, but more recently, systemic therapies have been developed, and their introduction has modified some of the surgical indications for rcc. In addition, refinements in surgical technique and the introduction of minimally invasive approaches have revolutionized patient care and bear the promise of even more improvements to come. This paper provides an up-to-date overview of recent developments in the surgical treatment of RCC.Current Oncology 06/2009; 16 Suppl 1:S8-S15. · 2.47 Impact Factor
Article: Predictive factors for ipsilateral recurrence after nephron-sparing surgery in renal cell carcinoma.[show abstract] [hide abstract]
ABSTRACT: Ipsilateral recurrence after nephron-sparing surgery (NSS) is rare, and little is known about its specific determinants. To determine clinical or pathologic features associated with ipsilateral recurrence after NSS performed for renal cell carcinoma (RCC). We analysed 809 NSS procedures performed at eight academic institutions for sporadic RCCs retrospectively. Age, gender, indication, tumour bilaterality, tumour size, tumour location, TNM stage, Fuhrman grade, histologic subtype, and presence of positive surgical margins (PSMs) were assessed as predictors for recurrence in univariate and multivariate analysis by using a Cox proportional hazards regression model. Among 809 NSS procedures with a median follow-up of 27 (1-252) mo, 26 ipsilateral recurrences (3.2%) occurred at a median time of 27 (14.5-38.2) mo. In univariate analysis, the following variables were significantly associated with recurrence: pT3a stage (p=0.0489), imperative indication (p<0.01), tumour bilaterality (p<0.01), tumour size >4cm (p<0.01), Fuhrman grade III or IV (p=0.0185), and PSM (p<0.01). In multivariate analysis, tumour bilaterality, tumour size >4cm, and presence of PSM remained independent predictive factors for RCC ipsilateral recurrence. Hazard ratios (HR) were 6.31, 4.57, and 11.5 for tumour bilaterality, tumour size >4cm, and PSM status, respectively. The main limitations of this study included its retrospective nature and a short follow-up. RCC ipsilateral recurrence risk after NSS is significantly associated with tumour size >4cm, tumour bilaterality (synchronous or asynchronous), and PSM. Careful follow-up should be advised in patients presenting with such characteristics.European urology 02/2010; 57(6):1080-6. · 7.67 Impact Factor
Chapter: La taille tumorale limite-t-elle encore les indications de la néphrectomie partielle en 2007?[show abstract] [hide abstract]
ABSTRACT: La taille tumorale est un facteur pronostique important dans le carcinome à cellules rénales (CCR). Elle a été démontrée comme étant une variable pronostique indépendante concernant la survie spécifique au cancer (SSC), la survie sans métastases et la survie sans extension ganglionnaire (1, 2). De ce fait, elle est la base de la classification TNM dans ses révisions de 1987, 1997 et 2002 pour les cancers localisés au rein (3). Elle sépare en Tl et T2 les tumeurs confinées au rein selon leur taille, respectivement inférieure et supérieure à 7cm. Pour les tumeurs Tl, on distingue deux sous-groupes, Tla et Tlb, en fonction de la taille tumorale, respectivement inférieure et supérieure à 4 cm. La valeur pronostique de ces séparations a été validée entre autres par Ficarra et al., au travers ďune large série multicentrique de 2217 patients atteints de RCC. Les survies spécifiques au cancer des groupes Tla, Tlb et T2 étaient respectivement de 91,4%, 83,4% et 75,2% (p=0,0003) (4).11/2008: pages 97-105;